KPEERI Only Pipeline Application | The Center for Effective Reading Instruction

Applicant Profile Information

Name*

First Middle Last Suffix

Address Type

International Address?

Business Address For Online Listing - USA*

Street Address Address Line 2 City State ZIP Code

Business Address For Online Listing - International*

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country

Email*

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Primary Phone*

Highest Degree Held*

Major*

Upload degree or transcript*

In order to take the KPEERI exam you must hold at least a bachelor’s degree. Your degree can be in a field other than education. Please upload a copy of your degree or transcript showing completion of your degree. (Section max file upload size 25MB.)

Drop files here or

Name of IDA Pipeline Program*

Are you Currently Teaching at a Public or Private School?*

Public
Private

What Grade(s) do you Teach?*

Is your School in an Urban, Priority, or Rural district?*

Yes
No

How Many Students do you Impact in One Academic Year With Structured Literacy in the Classroom?*

Why are you applying for the KPEERI Exam? (optional)

Additional Information / Comments (optional)

Please include any additional information related to this application.

Applicant Affirmation

IDA Branch*

By checking 'I agree', I give permission for CERI to share my contact information with my local IDA branch

I agree
I disagree

Affirmation*

I affirm that all of the information provided on this application is true and accurate and fully responsive to the questions asked. I have read and agree to abide by the code of ethics of the Center For Effective Reading instruction that are found within the Knowledge and Practice Standards. I agree to abide by all standards required to maintain my certification, including payment of annual fees and participation in continuing professional development activities. I understand that, once certified, my certification status may be made available to the public.

I agree
I decline

Payment

Institute or Program Paying for KPEERI Exam

Please note that institutional payment is subject to verification before an application can be processed.

No
Yes

Approved Programs for KPEERI Prepayment*

Documentation of Institutional Payment*

If your institution provided you with a voucher or other documentation of their willingness to pay your exam fee please upload it here. (Section max file upload size 25MB.)

Drop files here or

KPEERI Exam*

Price: $150.00

KPEERI Processing Fee*

Price: $15.00

(non-refundable)

Total

$0.00

Credit Card*

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Billing Address*

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